Desvenlafaxine succinate for major depressive disorder: a critical review of the evidence

Desvenlafaxine succinate (DVS) is the succinate salt monohydrate of O-desmethylvenlafaxine, an active metabolite of venlafaxine. DVS is a serotonin-norepinephrine reuptake inhibitor (SNRI) like venlafaxine, but exhibits a differential serotonergic and noradrenergic activity profile. A sustained-release form of DVS is approved by the US FDA for the treatment of adult major depressive disorder (MDD). DVS has shown efficacy for the treatment of MDD in clinical trials with doses ranging from 50 to 400 mg/day. The 50-100 mg/day dose range is therapeutic, with lack of additional benefit shown at higher dosages and a significantly higher risk of side effects, especially at the 400 mg/day dosing. Advantages of DVS over other sSNRIs include its simple metabolism, lower risk of drug-drug interactions and lack of need for extensive titration to achieve therapeutic efficacy. Limitations with the use of DVS include its moderate efficacy in the treatment of MDD, a safety-tolerability profile similar to that of other SNRIs and the possibility of transient discontinuation symptoms with cessation of DVS treatment. DVS is a useful addition to the options available for the treatment of MDD in light of the limited efficacy of currently available antidepressants.